Big Picture - April & May

This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Spring has been busy here at the Office of HIV Planning! We moved to our new office on the 3^rd floor of the building, in Suite 320. With all the difficulty of moving, we missed April’s Big Picture post, so we’ll cover both April and May here.

Finance Committee (May 12^th):

The Philadelphia EMA received a $162,000 increase in their Ryan White Part A funding this year. The Finance Committee looked over and approved budgets for Philadelphia, the PA suburban counties, and NJ. Because of HRSA Policy Clarification 16-02, the EMA’s emergency medication program cannot be funded the same way anymore.  Money to support the program was moved from the Local Pharmaceutical Assistance Program (LPAP) to Direct Emergency Financial Assistance (DEFA). Representatives from the AIDS Activities Coordinating Office (AACO) also requested that the Planning Council move $84,000 from LPAP to referral for healthcare and supportive services.

Ryan White Part A grant allocations meetings for the fiscal year 2017 will be held in June. The Pennsylvania allocations meeting will be June 14^th, Philadelphia will be on June 16^th, and NJ on June 21^st. The meetings will run from 1-4pm.

Needs Assessment Committee (April 11^th):

The results of the Needs Assessment Committee’s transportation survey are in. Case managers who responded to the survey talked about common issues with getting clients to and from medical appointments. Logisticare and SEPTA tokens were mentioned in a lot of the responses. The committee plans to look into issues with Logisticare and will possibly write a transportation resource list for case managers.

New Member Orientation/Nominations Committee (April 14^th & May 19^th):

The Planning Council welcomed 4 new members in April. They were invited to attend an orientation, where they learned about their responsibilities as Planning Council members. Debbie also gave an overview of the Ryan White Part A planning process.

In May, the Nominations Committee looked over Planning Council attendance. They’ll follow up with members who have attendance issues. They also reviewed the attendance policy. Members who have 3 unexcused absences or miss 5 meetings in a calendar year may be removed from the Planning Council. Anyone with a circumstance that keeps them from coming to meetings (for instance, an illness) should contact the office. Members should also try to arrive to meetings on time.

Ryan White Planning Council (April 14^th & May 19^th):

April: Evelyn Torres and Sebastian Branca from AACO gave a presentation on AACO’s Client Services Unit (CSU) at a joint meeting with the HIV Prevention Planning Group. The CSU helps to get people with HIV into case management and other services. AACO’s Health Information Helpline (1-800-985-2437) also provides information to callers from 8am-6pm Monday through Friday. Sebastian talked about the ways AACO follows up with HIV service organizations to see well they’re doing.  AACO uses data to see which organizations need help to improve their performance, and then helps organizations make plans for how they’ll do better.

May: The Finance Committee presented the budget for this year’s Ryan White Part A grant. The Planning Council voted to approve the budget, along with the grantee’s request to move $84,000 from LPAP to referral for healthcare and supportive services.

Positive Committee (May 9^th):

Antonio gave the Positive Committee a presentation on the 2015 Youth Risk Behavior Survey (YRBS). Philadelphia public high school students were asked about tobacco use, alcohol and drug use, body weight and activity, sex, and violence. You can see more information on Antonio’s slides here.

Nicole told the group about the OHP’s focus groups with high-risk heterosexuals. Participants in the focus groups talked about their experiences with healthcare in Philadelphia. You can read Nicole’s slides here. Also check out her full report along with her recent blog post, where she talks more about what she learned from the focus groups.

Comp Planning (April 21^st & May 26^th):

April: Nicole also gave her focus group presentation to the Comprehensive Planning Committee.

The Comprehensive Planning Committee looked over the Needs Assessment Committee’s transportation survey results. They agreed to brainstorm and work together with Needs Assessment on transportation issues.

The use of opioid medications and heroin is a huge problem in Philadelphia. Overdose deaths are on the rise. Hepatitis C rates among heroin users are also skyrocketing. The Comprehensive Planning Committee will continue to discuss the opioid epidemic at future meetings.

May: The Comprehensive Planning Committee has talked about a retention navigation program, transportation, housing, and health insurance premium cost-sharing over the last year. They asked AACO to look into a health insurance premium cost-sharing program for the Philadelphia EMA. The Positive Committee will address transportation at their next meeting. The Comprehensive Planning Committee will bring up the retention navigation model at this month’s Finance Committee and allocations meetings. The Planning Council will ultimately decide whether to fund the program.

HPG (April 27^th):

Kathleen Brady, AACO’s medical director, gave her annual report on the HIV epidemic in Philadelphia. The National HIV/AIDS Strategy and the HIV Care Continuum were an important focus of her presentation. See Kathleen’s slides for more information.

We hope to see you all at June’s allocations meetings!

Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.

Summer 2013 Update: Priorities and Funding

I shared this Prezi with the Positive Committee at their July 8, 2013 meeting, to give them an update on the Planning Council's activities over the last couple of months. A couple things for you to know/consider before viewing the Prezi:

• You can read more about the priority setting process, including the factors and scoring process here. The Comprehensive Planning Committee is responsible for facilitating the priority setting process at lest once every three years, or whenever there is a need to update the list due to policy or other changes to the care system. Priority setting just means putting the Ryan White care services in order of importance/need according to certain factors, based on information about community need and impact on the continuum of care. 

• The Philadelphia EMA received less of a decrease in the Part A funding than we were told to expect. The grant award was a little more than 6% less than the 2012 award. The Planning Council already developed a plan for a decrease, and this plan is represented by the 2013 pie chart in the Prezi. the 2012 pie chart is how the money was budgeted for last year. You will notice that the most significant differences are in Early Intervention Services and Care Outreach, which were ended as of the first quarter of this grant year (June 30, 2013), due to the funding decreases. Other services will receive less money too, because Early Intervention and Care Outreach Services couldn't absorb all of the cut.

• The Regional Allocations meetings where the community decides how to budget our Ryan White Part A funds will be at the Office of HIV Planning. Everyone is welcome to attend and participate. The Office of HIV Planning plans to provide meeting materials to participants before the meeting. If you would like to attend a meeting, please call 215-574-6760.
• PA Counties (Chester, Bucks, Delaware and Montgomery)- 
• Tuesday, July 23rd from 1-4pm
• NJ Counties (Camden, Burlington, Salem and Glouchester) - 
• Thursday, July 25th from 1-4pm
• Philadelphia - 
• Tuesday, July 30th from 1 - 4pm

Policy Update for Community Planners

There has been a lot of activity in the HIV policy world over the last several weeks. There has been so much going on that I decided to break up all the news and highlights into three blog posts. This post is for community planners, the other two will be for providers and individuals. I hope that you find one or more helpful and continue to educate yourself about health reform and the future of the Ryan White program. 

Ryan White Reauthorization

Ryan White Program Reauthorization Webinar from HIVHealthReform.org on Vimeo.

HIVhealthreform.org had a well-attended and informative webinar a few weeks ago on the reauthorization of the Ryan White Act (see above). You can read up a little bit on the issues on my past blog post. You can check out the slides from the webinar here. 

In short, the Ryan White Act will not be reauthorized this year, at least not in time for the "expiration" in the fall. No worries, the Ryan White program can and will still be funded and carry on. Budgets for 2014 from President Obama and Congress include funding for Ryan White.

Interesting fact: The law creating HOPWA (Housing Opportunities for People With AIDS) has never been reauthorized and the program carries on. 

New Kaiser Reports

Updating the Ryan White HIV/AIDS Program for a New Era: Key Issues and Questions for the Future - Kaiser Family Foundation

image courtesy of AIDSmap.org

This policy brief was released in April 2013 and highlights key issues and questions facing the Ryan White program, in light of recent scientific and policy developments.  The brief is divided into four main themes:

1. Supporting people with HIV at each stage of the Treatment Cascade, from diagnosis to viral suppression.
2. Building HIV care networks in underserved communities.
3. Integrating HIV care expertise into the mainstream health care system.
4. Effectively and fairly allocating Ryan White resources. 

Key issues from the brief for community planners: supporting the maximum number of people along the treatment cascade, integrating HIV care and prevention planning, updating the requirement that at least 75% of Part A funds go to "core services", payer of last resort concerns in the era of health reform, reconsideration of funding formulas to direct resources to communities of greatest need, and greater collaboration between HIV medical care and supportive services. 

Medicaid: A Primer - Kaiser Commission on Medicaid and the Uninsured

Kaiser also issued a comprehensive primer on Medicaid back in March. I recommend taking the time to read it, even if you think you know about Medicaid.  Topics include: Who is covered, what is covered, Medicaid's impact on access to care, costs of Medicaid, and who pays for Medicaid. 

Considering over half of the EMA's Ryan White clients are Medicaid-covered, an understanding of Medicaid's role in our health system is essential to good community planning, especially in the time of even more limited funding and health reform.

Kaiser has a great slide show about the role of Medicaid.

Payer of Last Resort

HRSA has released a few documents and resources concerning "payer of last resort" issues. It is important that Planning Council members have a clear understanding of what payer of last resort really means.

 ....“payer of last resort,” meaning that the Ryan White funds may not be used for any item or service for which payment has been made, or “can reasonably be expected to be made,” by any other payer. -- Joint CMS/HRSA informational bulletin (May 1, 2013)

There was another recent clarification released by HRSA concerning payer of last resort and eligibility of PLWHA for Ryan White services:


Clarifications Regarding Medicaid-Eligible Clients and Coverage of Services by Ryan 
White HIV/AIDS Program

....once an individual is enrolled in Medicaid, RWHAP funds may be used to pay for any medically necessary services which Medicaid does not cover or where Medicaid coverage is limited in scope, as well as premiums, co-pays and deductibles if required. RWHAP funds will continue to cover other core medical services such as adult dental, vision, or enhanced adherence and prevention counseling services as a part of primary care if those services are not covered or are limited under Medicaid, even when those services are provided at the same visit as Medicaid-covered services.  Policy Clarification Notice (PCN) #13-01

These statements are clear. Ryan White program funds CANNOT be used when ANY other payer (private insurance, Medicaid, Medicare, etc.) could cover the service for a RW-eligible client. This does not mean that Ryan White funds can "fill in gaps" in reimbursement for particular services; i.e. bridging the difference between the cost of providing the service and the third-party reimbursement. Ryan White funds can cover services that CANNOT be billed to another third-party, even if these services happen within the same visit or interaction as the Medicaid (or otherwise) reimbursed visit. 

Payer of last resort is such an important issue, because the Affordable Care Act (health reform) will enable more people living with HIV/AIDS to gain access to health insurance and more Ryan White services will be eligible for other third-party reimbursement. The Planning Council is responsible for developing priorities for the allocation of Ryan White funds, and must do so in a manner that takes into account ALL available resources within our EMA's HIV care system. At this point in time, we do not understand the full impact of health reform on the Ryan White system or the clients. The issue of payer of last resort will continue to be important throughout the planning and allocations process for 2014.

Towards more cost-effective HIV prevention planning

Some background: The Philadelphia Prevention Planning Group (PPG) and the City of Philadelphia's AIDS Activity Coordinating Office (AACO) work together to decide which communities have the greatest need for HIV prevention activities, and which interventions work best for those communities.  This is part of what we call "community planning."  AACO decides how the money gets spent and which organizations do the work, keeping in mind the community's needs and what is proven to work best. The PPG provides the community's voice to the process.

In 2011, the Centers for Disease Control and Prevention (CDC) approached the Philadelphia Department of Public Health (PDPH) to participate in the design and testing of a model for how to best spend HIV prevention funds to prevent the spread of HIV. The model was supposed to help health departments make cost-effective decisions to meet the goals of the National HIV/AIDS Strategy.  You can read more about the data used in the model and how the model influenced HIV prevention planning in the 2012 Philadelphia Jurisdictional Plan  (pages 93-95). 

AIDS.Gov recently released a podcast explaining this resource allocation model.  It also talks about the pilot project in Chicago, Nebraska, and Alabama, which is supposed to determine if the model works for those communities and to see if their experiences are similar to Philadelphia's.

The AIDS.Gov blog post explains more about the pilot project, HIV RAMP:

"That model was developed to help Philadelphia’s health department leadership identify the optimal allocation of HIV prevention funds across populations and prevention interventions that would prevent the most new HIV infections. Using local demographic and HIV epidemiological data inputs, and based on calculations of the cost per new infection averted, the model recommended the optimal allocation of the jurisdiction’s HIV prevention budget among several evidence-based interventions for the populations most impacted. Feedback from Philadelphia indicated that the model’s outputs served as a very useful “roadmap” to inform decision making for HIV prevention resource allocation within the jurisdiction, informing both applications for federal funds as well as efforts to strengthen local HIV prevention activities.

The current project, HIV RAMP, involves refining and piloting the original Philadelphia model in three additional jurisdictions that have different local profiles and HIV prevalence rates (Chicago, Nebraska, and Alabama), testing a technical assistance (TA) protocol to support jurisdictions in using the model, and assessing the feasibility of a software or online version of the model that could be more broadly used by other health departments.

“Because making decisions about how to spend HIV prevention funding is never ‘black and white,’ health departments need tools to help them decide how to support the best combinations of effective, evidence-based prevention strategies in their communities,” said Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health and Director of OHAIDP. “Through this pilot project, we hope to develop a practical tool that can help communities apply the principles of the NHAS on the ground.”

Here are some highlights from the Philadelphia jurisdictional plan's discussion of the model development, focusing on the results:

"Cost per new infection averted is an integral part of this resource allocation model. For HIV testing in a clinical setting, the cost per infection averted is $51,293, making it the second most cost-effective intervention for Philadelphia. Testing in non clinical settings for IDU (3) and MSM (1) rounded out the top three most cost-effective interventions for averting HIV transmission at $53,935 and $17,965, respectively. The least cost-effective interventions used in the model were behavioral interventions for HIV- high risk heterosexuals ($15,642,127) and IDU ($2,931,406). Behavioral interventions were not found to be as cost-effective as HIV testing, even for HIV+ individuals. Adherence to ART (4), retention in care (5), partner services, and linkage to care (8) were ranked in the middle of the list of interventions. 

The optimal resource allocations according to those calculations would avert 72 infections in the first year and 245 infections within five years. Testing in clinical settings would receive 39% of the resources and avert 20 infections in one year, 93 infections in five years. Retention in care would receive 29% of the resources and avert 27 infections in year one and 52 infections within five years....Two-thirds of the resources would be allocated to HIV testing in this optimal model, because of the cost-effectiveness of HIV testing (non-targeted), particularly for MSM and IDU communities.  These allocations would serve 1,930 HIV+ individuals and result in 792 new diagnoses. Return on investment ranges (prevention dollars only) from 1.21 in year one to 4.42 in year five....

Recommendations from the model include allocations decisions should be made by both cost and effectiveness. Testing should be prioritized in clinical and non-clinical settings. More resources should be allocated to interventions located in care-settings. Behavioral interventions for HIV- individuals are not allocated resources. Behavioral interventions for MSM can be allocated resources under certain conditions. "

If you want to learn more about the community planning of HIV prevention in Philadelphia, check out the Prevention Planning Group or come to a meeting.

The Big Picture - March 2013

This post is part of a monthly series (that's usually) published on the fourth Thursday of every month. It provides an overview of themes and topics from the general meetings and committee meetings of the Ryan White Planning Council and Prevention Planning Group each month. To view meeting materials and presentations, please visit www.hivphilly.org.

Ryan White Planning Council (RWPC)

Last month, the Planning Council (RWPC) did some contingency planning for what we'll do once we receive our full award from the federal government.  (Read what happened last month here.)  We don't know how much funding we have for the fiscal year that started on March 1, but we received some new information midway through the month.  We got this information after the RWPC already met, so the Finance Committee and RWPC held emergency meetings. 

In February, we already knew that we should expect a 5.1% cut to Ryan White funds due to the sequester, so the RWPC planned accordingly.  However, in March, HRSA told our area that we should expect an additional 5.2% cut, because our area's portion of HIV/AIDS cases had risen slower than cases in other areas.  All in all, the grantee (otherwise known as AACO, or the AIDS Activities Coordinating Office) suggested that the RWPC plan for an 11% cut.  This would be about a $2.1 million cut to funding for services.  The grantee also developed a suggestion that they believed would minimize the impact of the cuts on consumers.  This suggestion was reviewed at length by the Finance Committee and the larger RWPC, and ultimately approved by both.  The final plan ends funding for early intervention services and care outreach after the first quarter, and spreads the remaining cuts proportionally across the other services.

Earlier in the month, the RWPC received a treatment update from Dr. Chris Vinnard.  They also learned about Early Identification of Individuals with HIV/AIDS from consultant Matthew McClain.  The Comprehensive Planning Committee continued and honed its conversation on Ryan White service categories and their relationship to the continuum of care.  They also talked about reimbursement for Ryan White services and the need for a peer navigator program.  Meanwhile, the Needs Assessment Committee discussed how and where people enter into HIV care. The Positive Committee listened to a podcast on the Origin of HIV and received a policy update.  The Finance Committee (in their first meeting of the month) also got a policy update, before discussing the care continuum chart developed by the Comprehensive Planning Committee last month.  Last but not least, the Nominations Committee met to review applications for RWPC membership.  Seven out of eleven applications were approved, and the new members will take their seats on the Planning Council in April.
 

Prevention Planning Group (PPG)

The PPG met this month to receive a special presentation from AACO epidemiologist Dr. Kathleen Brady.  She gave an overview of the latest data on the HIV/AIDS epidemic in the Philadelphia area in order to help the PPG complete its work.  The PPG also continued its process of reinventing itself.  This month, consultant Matthew McClain presented an updated version of the group's draft bylaws based on the recommendations from the last meeting.  He also developed a draft version of a new membership application.  PPG members were asked to review the draft documents so they could provide suggestions and changes at the next meeting.

The Points of Integration Workgroup, a joint venture of the PPG and RWPC, met at the beginning of the month to develop their work plan for the rest of the year.  They continue to examine the process of linking newly diagnosed HIV cases into the care system.


This is an exciting time to get involved in community planning for the Philadelphia area. To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org to find out how to get involved.  If you have questions, you can also call us at 215-574-6760.

The Spotlight: Ryan White Funding Update

If you are confused about Ryan White Program funding and how the sequester will affect our local HIV care system, you are not alone. I hope this post provides you with some information and resources that alleviate some uncertainty and provide context for the Planning Council's work.

Ryan White Reauthorization

The Ryan White HIV/AIDS Treatment Extension Act (2009) expires this fall, but this does not mean that the Ryan White Program will discontinue. Congress can (and will) appropriate funds to the Program, even if the Act is not reauthorized. The previous reauthorizations of the Act had sunset provisions, which meant that if the law was not reauthorized by a set date, Congress would not be able to appropriate funds and the program would end. The sunset provision is not a part of the current act.

 

Presdent Obama and Ryan White's mother
at the signing of the 2009 reauthorization

Community advocates and federal partners agree this is not the best time to seek reauthorization, because of the current fiscal crisis and lack of bipartisan Congressional support of health reform. They feel it is too risky to call attention to an HIV-specific health care law; some members of Congress may believe such a program is no longer needed in the era of health reform. Congressional understanding of the program varies. Many members of Congress are new to the job this year (12 Senators and 67 representatives) and they need to be educated on the importance of the Ryan White Program before we can ask them to think about reauthorization.

 

The CAEAR Coalition and NASTAD provide regular updates on Ryan White Program funding and policies.
 

Sequester 

Because Congress didn't compromise on federal budget reduction in January, the sequestration of funds or sequester was triggered. This means an automatic, across-the-board 5.1% cut to every discretionary line item in the federal budget, excluding entitlements like Social Security and Medicaid/Medicare. As outlined in a report issued by the White House, the sequester cuts funding for HIV testing, HIV treatment, and research efforts. It also cuts funding to the states (Pennsylvania and New Jersey fact sheet) and the Philadelphia EMA, in more programs than just Ryan White. We are anticipating at least a 5.1% cut to the Ryan White program, but this is not a certainty. We could lose more or less funding. We will not know until later this year (see the discussion below on the funding for FY2013 and the continuing resolution). The sequester will not go away after this year. It affects the next decade of federal budgets, unless Congress and President Obama come up with an alternative plan.

 

The Bipartisan Policy Center has a great guide on the sequester.
 

Ryan White Funding FY2013 (started March 1, 2013)

Not only are we dealing with a sequester, but we also have a continuing resolution. A continuing resolution is a common way for Congress to avoid a formal appropriations process, and just carryover the budget from one year to the next. The continuing resolution can be for one year, six months, or any other period of time. We are currently working under a continuing resolution that ends on March 27th. If Congress does not pass another continuing resolution or pass appropriation bills before then, we could face a federal government shut down like we saw in 1996 and 1997. President Obama and Congressional leaders don’t want a shutdown, so it is likely we will have another continuing resolution. Funding might be "level" to the Ryan White Program for 2013, BUT would still have a 5.1% cut from the sequester.

 

Level funding to the Ryan White Program nationally does not mean the Philadelphia Eligible Metropolitan Area (EMA) will receive a grant award equal to FY2012’s award. Our EMA’s Part A grant award is based on two awards - a formula award based on living HIV and AIDS cases and a supplemental award based on the grant application’s score. In planning for FY 2013 and beyond, we are anticipating AT LEAST a 5.1% ($1.1 million) decrease in Part A funding to the EMA.  This reduction in funding will carry over into the FY 2014 allocations process that we are just beginning. This is also why the Planning Council decided to base the EMA’s FY2013 budgets on the 5% decrease scenarios from last summer’s planning process.

 

Matthew McClain’s presentation from the February 2013 Planning Council meeting offers additional information and resources about domestic HIV policy.

The Big Picture - February 2013

This post is part of a new monthly series published on the fourth Thursday of every month. It will provide an overview of themes and topics from the general meetings and committee meetings of the Ryan White Planning Council and Prevention Planning Group each month. To view meeting materials and presentations, please visit www.hivphilly.org.

Ryan White Planning Council (RWPC)

Every summer, the Planning Council (RWPC) makes contingency plans for how it will spend money for fiscal year, which starts the following spring. That way, they have a plan when they find out how much money they’ll be getting from the federal government. Grant awards come out at a different time every year, based on when the federal budget is finalized. As of the writing of this post on February 28, 2013, we have not yet received our full award for the fiscal year starting on March 1, 2013. This year, planning will be unusually challenging.

We are facing an impending sequester and the end of the continuing resolution (a type of continuation budget when Congress fails to make appropriations). Although the Ryan White program will still be fundable, the Ryan White Treatment Modernization Act is set to expire in the fall. While this could complicate our responsiveness to changes caused by the Affordable Care Act, government and community leaders decided not to seek reauthorization due to political and budgetary concerns. We’re also uncertain about the impact of Medicaid expansion – which, at this time, is very likely in New Jersey and unlikely in Pennsylvania. It could be called a perfect storm. (Learn more here.)

To prepare for a rocky year, the RWPC and its committees have pressed forward with their work. The Finance and Comprehensive Planning Committees have already begun to talk about the summer’s allocation process. The Finance Committee has agreed to hold two allocations processes this year: one in the traditional format, and a second that addresses potential changes caused by national-level issues. Since we are not sure how much money we’ll have for the year starting March 1, 2013, the Finance Committee recommended that we act as if we have received a 5% cut (a suggestion then approved by the RWPC).

Meanwhile, the Comprehensive Planning Committee looked at how the Ryan White service categories fit in the continuum of care. (Learn more about the continuum of care here.) The Needs Assessment Committee received a presentation from the AIDS Activities Coordinating Office (AACO) on its Client Services Unit (CSU) and quality management, so they would have a better idea of how to measure the effectiveness of the different services. The Positive Committee talked about disclosure and reviewed their goals and objectives. The Nominations Committee also discussed their policies and next steps in uncertain times. They’re also accepting applications for RWPC membership through the second week in March.

Prevention Planning Group (PPG)

In the second half of 2012, the PPG and RWPC jointly explored the idea of combining care and prevention planning in one body. This idea was tabled due to the uncertainty that surrounds the current planning environment. But, the PPG was still in need of a change. The CDC released new HIV Planning Guidance in July 2012, marking a shift away from the old duties of prevention planning.

In order to decide what the future of prevention planning should look like in Philadelphia, the PPG called two special February meetings: one on structure, and another on membership. A small group of dedicated members began the hard work of ironing out the details. They chose to recommend that the PPG have 12 – 20 voting members (plus non-voting members), who would meet every other month to plan for stakeholder engagement. They also recommended that the PPG build more flexibility into its process. (Read a summary of points from the workgroup meetings.)

When the PPG met in February, consultant Matthew McClain presented draft bylaws based on the recommendations from the two workgroups. He also created an outline of a work plan for the new group. After a thorough review of the bylaws, PPG members identified a few areas for change as well as their next steps. In coming weeks, the PPG will create roles and responsibilities for voting and non-voting members. They will also develop an application and scoring process, beginning with a special membership meeting.

This is an exciting, if tumultuous, time to get involved in community planning for the Philadelphia area. To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org to find out how to get involved.

2012 Ryan White Allocations

Every year, the Philadelphia EMA Ryan White Planning Council (RWPC) hosts three Allocations meetings for each region in the Eligible Metropolitan Area (EMA) to plan its budget for the next year. One meeting is for the New Jersey counties (Salem, Camden, Gloucester, and Burlington), one is for the PA suburban counties (Bucks, Chester, Montgomery, and Delaware), and the third is for Philadelphia County. Each region receives a portion of the total EMA's funding that reflects their share of the HIV/AIDS epidemic, based on the most recent data available.

At the Allocations meetings, each region makes a plan for how they would spend their portion of the funding if the EMA received the same amount of money as last year, if they received a 5% decrease in funding, and if they received a 10% increase in funding. These plans are for the fiscal year that begins on March 1 of the next year. Each region can also make instructions to the grantee (the AIDS Activities Coordinating Office, or AACO) at its meeting.

After these three meetings, the Finance Committee of the Ryan White Planning Council (RWPC) meets to review each region's plan, including any instructions to the grantee. The Finance Committee can choose to recommend, recommend against, or make no recommendation on these plans (although the Finance Committee almost always recommends the regional plans with no changes). The Finance Committee then presents the allocations plans from all three regions to the RWPC, who then votes on the plans and the instructions to the grantee.

The allocations plans for next year were based on the 2009 number of living HIV/AIDS cases in each region. Based on this data, the PA suburban counties represent 14.20% of living HIV/AIDS cases in the EMA, while the New Jersey counties represent 10.55% of cases and Philadelphia represents 75.25%. These shifts provided the starting point for each region's decision-making.

Here's the breakdown for each region.

Philadelphia
Level-funding budget: Philadelphia chose to keep all services funded at the same levels in the case of level funding.

5% decrease budget: Philadelphia chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% increase budget: Philadelphia chose to give core service categories a 9% increase (based on their level-funding budget), while giving supportive service categories an additional 1% increase on top of their other 10% increase.

Instructions to the grantee: Philadelphia instructed the grantee to provide utilization data (to the Comprehensive Planning Committee) and expenditure data (to the Finance Committee) for the current and previous fiscal years. Philadelphia also instructed the grantee to clarify whether there were any organizations that provided treatment adherence services, but did not provide medical case management services.

PA Suburban Counties

Level-funding budget: The PA suburban counties chose to keep all services funded at the same levels in the case of level funding.

5% decrease budget: The PA suburban counties chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% increase budget: The PA suburban counties chose to spread a proportional increase across all service categories with the exception of transportation and drug reimbursement (based on their level-funding budget), because these categories had been underspent. They instructed the amount of the increase that would otherwise go to transportation and drug reimbursement (approximately $53,746) be placed into other categories as follows:

• 25% into medical case management


• 25% into ambulatory care


• 50% spread across all remaining service categories

Instructions to the grantee: The PA suburban counties instructed the grantee to analyze outreach services in Chester city, with the results reported to the Comprehensive Planning Committee.

New Jersey Counties
Level-funding budget: The New Jersey counties chose to move funding from food bank/home-delivered meals (leaving a $5 placeholder) into state ADAP, as there were no providers currently able to provide food bank/home-delivered meals and the state ADAP program had received cuts.

5% decrease budget: The New Jersey counties chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% increase budget: The New Jersey counties chose to spread a 10% increase proportionally across all service categories (based on their level-funding budget).

Instructions to the grantee: The New Jersey counties instructed the grantee to review the efficacy of the medical case management model (to be reported to the Comprehensive Planning Committee), and to possibly expand the model to include triage.